A Psychiatric Milestone | Page 9

child and mother, child and father, the child as a
reagent to the relations between mother and father, brothers and sisters,
companions and community--in the competitions of real concrete life.
It has furnished a concrete setting for the interplay of emotions and
their effects.
It has led us from a cold dogma of blind heredity and a wholesale
fatalistic asylum scheme, to an understanding of individual, familiar,
and social adjustments, and a grasp on the factors which we can
consider individually and socially modifiable. We have passed from
giving mere wholesale advice to a conscientious study of the problems
of each unit, and at the same time we have developed a new and
sensible approach to mental hygiene and prevention, as expressed in the
comprehensive surveys of State and community work and even more
clearly in the development of helps to individuals in finding themselves,
and in the work in schools to reach those who need a special adaptation
of aims and means. To the terrible emergency of the war it was possible
to bring experienced men and women as physicians and nurses, and
how much was done, only those can appreciate who have seen the
liberality with which all the hospitals, and Bloomingdale among the

first, contributed more than their quota of help, and all the assistance
that could possibly be offered to returning victims for their
readjustment.
It is natural enough that psychiatry should have erred in some respects.
We had forced upon us the herding together of larger numbers of
patients than can possibly be handled by one human working unit or
working group. The consequence was that there arose a narrowing
routine and wholesale classifications and a loss of contact with the
concrete needs of the individual case; that very often progress had to
come from one-sided enthusiasts or even outsiders, who lost the sense
of proportion and magnified points of relative importance until they
were supposed to explain everything and to be cure-alls. We are all
inclined to sacrifice at the altar of excessive simplicity, especially when
it suits us; we become "single-taxers" and favor wholesale legislation
and exclusive State care when our sense for democratic methods has
gone astray. Human society has dealt with the great needs of psychiatry
about as it has dealt with the objects of charity, only in some ways
more stingily, with a shrewd system and unfortunately often with a
certain dread of the workers themselves and of their enthusiasm and
demands. Law and prejudice surrounded a great share of the work with
notions of stigma and hopelessness and weirdness--while to those who
see the facts in terms of life problems there can be but few more
inspiring tasks than watching the unfolding of the problematic
personality, seeking and finding its proper settings, and preventing the
clashes and gropings in maladjustments and flounderings of fancy and
the faulty use and nutrition of the brain and of the entire organism.
What a difference between the history of a patient reported and studied
and advised by the well-trained psychiatrist of to-day and the account
drawn up by the statistically minded researcher or the physician who
wants to see nothing but infections or chemistry and hypotheses of
internal secretion. What a different chance for the patient in his
treatment, in contrast to what the venerable Galt of Virginia reports as
the conception of treatment recommended by a great leader of a
hundred years ago: "Mania in the first stage, if caused by study,
requires separation from books. Low diet and a few gentle doses of
purging physic; if pulse tense, ten or twelve ounces of blood [not to be
given but to be taken!]. In the high grade, catch the patient's eye and

look him out of countenance. Be always dignified. Never laugh at or
with them. Be truthful. Meet them with respect. Act kindly toward
them in their presence. If these measures fail, coercion if necessary.
Tranquillizing chair. Strait waistcoat. Pour cold water down their
sleeves. The shower bath for fifteen or twenty minutes. Threaten them
with death. Chains seldom and the whip never required. Twenty to
forty ounces of blood, unless fainting occurs previously; ... etc."
To-day an understanding of the life history, of the patient's somatic and
functional assets and problems, likes and dislikes, the problem
presented by the family, etc.!
So much for the change within and for psychiatry. How about
psychiatry's contribution beyond its own narrower sphere? It has led us
on in philosophy, it has brought about changes in our attitude to ethics,
to social study, to religion, to law, and to life in general. Psychiatric
work has undoubtedly intensified the hunger for a more objective and
yet melioristic and really idealistic philosophical conception of reality,
such as has been formulated in the modern concept of integration.
Philosophical tradition,